Project Summary World Health Organization established that every year, around the world, between 250,000 and 500,000 people suffer a spinal cord injury (SCI). While existing research suggests links between the injury event, early care, and rehabilitation outcomes, there still remains a critical knowledge gap ? about how characteristics associated with trauma and acute phases of SCI can allow us to better understand functional recovery post- SCI. In the past, this research was partly hampered due to databases that either focused on trauma-care or inpatient rehabilitation. However, using advanced analytical methods, we are now in a position to combine databases that contain trauma and acute phase-related variables with patient-level characteristics to assess longitudinal functional recovery over time. Trauma and acute phase-related variables include type of trauma, cause of injury, process of care, clinical data, and outcome data during acute care. The overall objective of this study is to use trauma and acute phase-related variables to explain the longitudinal functional recovery of individuals with SCI, from acute to post-acute to community. This will be achieved by probabilistically linking the Pennsylvania Trauma Systems Outcomes Study (PTOS) database with the National Spinal Cord Injury Model Systems (SCIMS) database. The PTOS and SCIMS databases provide complimentary information about trauma and acute phases of SCI from acute hospital to inpatient rehabilitation facility (IRF) to community. The long-term goal of our research is to identify trauma and acute phase-related variables that can be utilized during acute care and post-acute rehabilitation interventions to improve clinical decision making, which in turn enhances rehabilitation programs.The central hypothesis of this proposal is that trauma and acute phase- related variables, combined with patient-level characteristics, will significantly predict longitudinal functional recovery in individuals post-SCI. Our hypothesis is guided by prior research and our pilot work with the PTOS database. A primary objective of this proposal is to examine the association between trauma and acute phase- related variables with functional improvements during IRF in individuals with traumatic SCI using machine learning ensemble methods (Aim 1). A secondary objective of this study is to develop longitudinal trajectories of functional recovery over a period of 1-year post-SCI taking into account trauma, acute phase, and patient- level characteristics during acute, post-acute, and community living using growth curve modelling (Aim 2). The proposed study will yield novel insights about the relationship between trauma and acute phase-related variables with functional status.